Inspection on 05/05/05 for The Cedars

This inspection was carried out on 5th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Cedars 30/09/09

The Cedars 26/09/07

The Cedars 26/10/06

The Cedars 25/04/06

The Cedars 10/10/05

The Cedars 25/01/05

The Cedars 13/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Cedars 45 Queens Road Oldham OL8 2AH Lead Inspector Carol Makin Unannounced 5th May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Cedars Version 1.10 Page 3 SERVICE INFORMATION Name of service The Cedars Address 45 Queens Road Oldham OL8 2AH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0161 626 4665 0161 626 4665 Mrs Eileen Ashton Mrs Eileen Ashton CRH 12 Category(ies) of Dementia (DE) - 2 registration, with number Dementia - over 65 years of age DE(E) - 4 of places Old age, not falling within any other category (OP) - 12 The Cedars Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1 2 3 Service users to include up to 12 OP, up to 2 DE and up to 4 DE(E). No service user to be admitted into the home under 60 years of age. A Manager, working a minimum of 30 hours each week, must be in place at all times who has the qualifications, skills and experience necessary for managing the home and who is registered, or has an application for registration pending, with the Commission for Social Care. Date of last inspection 25th January 2005 Brief Description of the Service: The Cedars is a small, family run care home for up to 12 service users. The home is situated one mile from Oldham town centre, close to local amenities and public transport. Accommodation is provided in six single bedrooms, four of which have en-suite toilet facilities, and three twin rooms with en-suite toilets. Privacy screens are provided in the shared rooms. There is a large lounge and a lounge/dining room; there is also a small separate lounge at the rear of the property which is a designated smoking area for service users. Level access to one of the dining rooms is not provided, service users must negotiate one step; grab rails are in place for those service users who may need assistance. The front of the home provides a large garden area overlooking the park with seating areas for service users. A small amount of car parking space is available at the rear of the property. The Cedars Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on 5th May 2005. Action had been taken in relation to some of the requirements, which were made as a result of previous inspections. Some had been fully addressed, but others required further improvement to meet the National Minimum Standards and the Regulations, and there were others for which no action had been taken. The inspector spoke with some of the residents, the manager and a member of care staff, carried out a partial inspection of the premises, and examined records. Verbal feedback of the findings of the inspection was given to the manager, during, and at the end of the inspection. What the service does well: What has improved since the last inspection? Some maintenance work had been carried out to the premises. A programme of enclosing radiators for safety reasons had begun. New carpets and colour co-ordinated bed linen had been provided in some of the bedrooms. A new washing machine, which meets disinfection standards, had been provided. The Cedars Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Cedars Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Cedars Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Resident’s needs are assessed before they move into the home. EVIDENCE: The records of the most recently admitted resident, provided the following information about the procedure which had been used to assess her needs. A detailed assessment and care plan for the prospective resident had been faxed to the home by a social worker on the day before the admission took place. The deputy manager said that she had discussed the lady’s needs with the social worker by telephone, and with relatives when they visited the home on the lady’s behalf to assess its’ suitability. Based on the information which she was given, the deputy felt that the lady’s needs could be met at The Cedars, and she therefore agreed to the admission. The Cedars Version 1.10 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,9,10 Care plans did not fully indicate resident’s needs. The home’s practice in handling medication was unsafe. The rights of rights are protected. EVIDENCE: Care plans included some useful guidance for staff, but a pro-forma was used which had been obtained from another care home, and some points did not relate to the resident concerned or to The Cedars. One resident had a history of falls prior to admission, and had suffered a fall since admission. Falls were noted in a care plan regarding mobility, but there was no specific risk assessment or care plan for the prevention of falls. Some details about the specific assistance required by residents, which was noted in the assessments and care plans from social workers had not been included in the homes assessments and a specific care plan was not always available for each identified need. Reviews of care plans had been carried out each month. The Cedars Version 1.10 Page 10 Residents and/or their representative also need to sign care plans and reviews to confirm that they have been involved in the process and agree with the care plan. A number of concerns were identified in respect of the home’s handling of resident’s medication, specifically: Staff had added medication to the monitored dosage system cassette, which was not listed on the medication administration record (MAR sheet). This is not considered to be good practice, as medication must only be administered from the containers dispensed by a pharmacist or dispensing doctor. Staff had not checked medication when it was received from the pharmacist to ensure that all of the required medication had been delivered. The date of opening eye drops was not recorded on the container. Medication was not retained for 7 days after the death of a resident in case there is a coroner’s inquest. A record had not been kept of the date when medicines were returned to the pharmacist. Certificates of training in medication, for the 6 members of staff (including the manager and the deputy) who administer medication, were displayed in the home, for training which was provided in March 2003. Residents felt that their rights to privacy and dignity were upheld by the staff. The Cedars Version 1.10 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 Residents enjoy a flexible lifestyle in the home and maintain contact with their families. Residents receive an appropriate diet. EVIDENCE: Residents felt that the routines of daily living within the home were flexible, and they were able to give examples such as getting up and going to bed when they wished. They were satisfied with the activities provided e.g. cards, dominos, board games, bingo, and one lady particularly enjoyed doing crosswords and word puzzles. Residents said that visiting was able to take place at any reasonable time, and their visitors were made welcome by the staff. The food was enjoyed by residents, which they said was good and plentiful. The Cedars Version 1.10 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of the standards in this section were assessed on this occasion. EVIDENCE: The Cedars Version 1.10 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,21,24,25,26 The environment was not fully maintained to ensure the safety of residents. Bedrooms and communal areas were clean, homely, and pleasant. EVIDENCE: Large containers of cleaning fluid continued to be stored beneath the washbasins in the resident’s toilet area on the first floor. The manager had put a net curtain in front of them since the last inspection, but this did not meet the requirement for hazardous products to be stored in locked facilities at all times, which was made as a result of that inspection. It was noted that a toilet seat needed replacing and the toilet frames were rusting at the base and need either repairing or replacing. New carpets and colour co-ordinated bed linen had been provided in some bedrooms since the last inspection, which looked very attractive. Damaged vanity units and bedside cabinets had not, however been replaced. The Cedars Version 1.10 Page 14 Screening was provided around washbasins in shared rooms but not between beds. This was an issue in a shared room in which one resident chose use a commode instead of the en-suite toilet. A programme of enclosing radiators was progressing, but the radiator guards were such that it was not possible to control the heating in the bedrooms. The manager said that she expected the work to be completed by the end of the month (May 2005). A new washing machine which meets disinfection standards, had been provided since the last inspection, to ensure that resident’s laundry is thoroughly clean. Residents said that they were satisfied with the laundry service in the home. Standards of cleanliness within the home were satisfactory. Residents had furniture and other personal possessions in their bedrooms to meet their needs and make them homely. The Cedars Version 1.10 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 The number of staff on duty in the home during week ends, was not sufficient to meet the residents needs. The home’s practice for recruiting new staff did not protect residents. EVIDENCE: Information provided for inspection showed there were only 2 carers duty on each day shift on Saturday and Sunday to provide personal care for the residents and do the cleaning and cooking, with the exception of Sunday morning when a domestic worker was on duty to do the cleaning. The records for a newly appointed member of staff were inspected. A POVA first check and a second reference had not been obtained before appointing the person. The owner’s continued failure to comply with requirements made by the Commission for Social Care Inspection, to operate a recruitment procedure which protects the residents, was of such concern that it was taken up with the her by letter, ahead of this report. The Cedars Version 1.10 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,34,36,37,38 The manager had difficulty in assimilating some of the National Minimum Standards into practice, and understanding the legislation. The management style did not provide staff with sufficient supervision, or monitor safe working practices. Record keeping could be improved to safeguard resident’s rights, and more opportunities were needed for residents to comment on the running of the home. Business and financial plans were needed to demonstrate the financial viability of the home. EVIDENCE: The Cedars Version 1.10 Page 17 The manager said that she found it difficult to cope with “all the new standards and regulations”. Her management style was sometimes unstructured and informal. No restrictive practices in the home were observed in the home, or indicated in discussions with residents. During 2004 questionnaires had been sent to resident’s relatives and friends, and visiting professionals, to ask their views about the service provided at The Cedars. A brief summary of the survey had been provided, which concluded that the findings were overall positive, but also included areas where improvement was needed. Whilst this demonstrated that progress had been made in providing a system for monitoring the quality of the service provided at the home, the system needed to be extended to enable the residents to have more opportunities to be involved in the running of the home. As on previous inspections, there were no business or financial plans, despite requirements having been made at previous inspections. Interviews with a member of staff and with the manager revealed that formal supervision was not being provided for staff. The manager said that she planned to implement a system of formal supervision by the end of the month (May 2005). Some forms and stationery, had prepared for the purpose. As on previous inspections, some of the records, which are required by statute, did not meet the standard, as noted previously in this report when reporting on standards 7, 9,29. There was evidence that accidents were not being recorded in the accident book as required. Issues about the safe storage of hazardous products not being locked away, which are noted in standards 19-26, have an impact on resident’s safety. Food had not always been properly resealed after opening, and fridge and freezer temperatures had not been recorded since 8th April 2005, to check whether food was being stored at the correct temperature. The Cedars Version 1.10 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 x 2 x x 2 2 3 STAFFING Standard No Score 27 2 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x 2 2 2 x 1 2 2 The Cedars Version 1.10 Page 19 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7, 37 Regulation 15 Requirement The registered person must ensure that care plans are provided for all the assessed needs of residents, and are reviewed in detail, to provide guidance for care staff in meeting those needs. (Timescale for immediate action not met). The registered person must ensure that residents and/ or their representative are involved in drawing up care plans, and sign them to confirm this. The registered person must ensure that medication is administered and recorded in accordance with the Standards and the Regulations. (Previous timescale for action was not met). The registered person must ensure that a record is kept of the date when medication is returned to the pharmacist. The registered person must ensure that furniture in service users’ private accommodation is well maintained at all times. (Previous timescale of 1/03/05 was not met). Version 1.10 Timescale for action immediate 2. 7 15 immediate 3. 9 12,13,17 immediate 4. 9 17 immediate 5. 24 16,23 1/8/05 The Cedars Page 20 6. 19, 25 13 7. 27 17,18 The registered person must ensure that pipe work and radiators are guarded or have low temperature surfaces. The registered person must ensure that staffing levels are increased at weekends. The registered person must operate a thorough recruitment procedure which ensures that service users are protected. The registered person must ensure that staff records are kept in accordance with this standard and the regulations. (Previous timescales for immediate action were not met). The registered person must ensure that quality assurance and quality monitoring systems are improved to meet the National Minimum Standards. The registered person must ensure that a financial plan and a business plan are available for inspection. The registered person must ensure that a programme of formal supervision is implemented for all staff in accordance with the National Minimum Standards. The registered person must ensure records required by legislation are maintained and made available for inspection at all times. The registered person must ensure that food is effectively resealed after opening. The registered person must ensure that freezer temperatures are recorded daily. Version 1.10 1/7/05 immediate 8. 29 17(2) schedule 4 19 schedule 2 Care Standards Act S89 immediate 9. 33 24 (1)(a) 1/9/05 10. 34 17 schedule 4, 25 18 1/7/05 11. 36 30/6/05 12. 37 17 immediate 13. 21,38 13,16,23 immediate immediate The Cedars Page 21 The registered person must ensure that hazardous products are appropriately stored in locked facilities at all times. (Previous timescales for immediate action were not met). immediate RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 9 Good Practice Recommendations The registered person should ensure that staff receive up to date training regarding the administation, storage and disposal of medication. The Cedars Version 1.10 Page 22 Commission for Social Care Inspection 2nd Floor, Heritage Wharf Portland Place Ashton under Lyne OL7 OQD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Cedars Version 1.10 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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